Peer review of this paper Throughout modern medicine the Hippocratic oath of do

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Peer review of this paper
Throughout modern medicine the Hippocratic oath of do no harm has been the starting point for many physicians. While at the center of nursing principles the idea of non-maleficence is at the foundation. While these two ideas on a surface level are well intentioned, the practicality of them sends healthcare workers into the murkier waters of ethics. As it stands, there are few murkier ethical waters than the idea of physician assisted death.
While at first thought the idea of physician assisted death might not pass the initial gut check, it is in fact an ethical course of action to take in certain scenarios. If a patient receives a terminal diagnosis and his or her options are intensive, painful, long-lasting procedures with a low success rate, or suffering until they die, then a third option begins to stand out more. Throughout this paper the ethics of physician assisted death will be studied and contrasted.
If a patient is suffering and no longer wishes to be alive, it should be no ones right except the patients to make that decision. There can be several examples given to show why physician assisted death should become normalized in American healthcare. Some examples include patients with severe and aggressive cancer, patients who have had multiple heart surgeries who can not get better, and drug addicts with multiple organ failure. In all these situations, the patient will not get better, and there only outcome is a slow deterioration until death. While some family members and medical professionals might not like the idea of physician aided death, it should be up to the individual and the healthcare team to find someone who specializes in this area, and to allow it to happen. Simply put, the pros are the person actively suffering get to be freed from their pain and get what they want in their last moments, while the cons are heartbreak for those that are left behind.
At first, the primary question should be, is the patient looking for physician assisted death, are their family members pushing for it, or is it a mixture of these two ideas. In a study done by the Journal of the American Medical Association, 828 physicians returned a questionnaire that stated 12% of these physicians had received an explicit request to help end their lives. (Back et al JAMA 1996) From a Kantian perspective, the idea of acting out how you would want others to do stands out. (Textbook page 38) If the healthcare worker were in the patient’s situation would he or she want to continue living or would they want to obtain as much treatment as possible. Additionally, the basis of Kantian principle’s, is do not kill, do not cause pain, do not deprive people of freedom, and do your duty. (Textbook page 46) This can lead to moral dilemmas. A cancer patient wishes to die, so that they will no longer be in pain, is following Kant’s principle of acting out how they would want to be treated. Yet the physician acting on the patient’s behalf would be disregarding the same principles by helping to aid in the patient’s death. In the end, following Kant’s categorical imperative, we gain an answer to this dilemma. Since morality is meant to guide actions, then what is right is to follow through with the patient’s wishes. With this being said, “there is an important difference between passively allowing to die and actively killing.” (Grasi et al. Complex Medical-Psychiatry Issues 2022) This is why the words physician assisted death is used instead of physician assisted suicide. The patients that would fall under the category of being allowed to die are already mortally ill and have no chance of recovery, as compared to those that could recover, but for whatever belief they have, they do not want to. Going back to Kant’s principles, it would be unethical to be the causative reason for someone’s death, while it is still ethical to hasten the process for those already along the path. Additionally, there is no universal action for people requesting to be allowed to die, nor is there a way to measure the singular aspect of physician assisted death as seen through Kant’s ideologies. There is, however, Kant’s categorical imperative which says the moral action ought to be conducted if it is right. It should be a patient right to choose what is there correct for themselves. Which leads to the concluding point when reviewing this subject through a Kantian lens, healthcare, the government, or any other authority should not prohibit people from acting on what they believe is right.
From a utilitarianism lens, physician assisted death should be looked at what will maximize the happiness and well-being for all affected individuals. This can be looked at interchangeably between the three parties affected. Those parties are the healthcare workers, the patient wanting the physician’s aide, and the family members. Interestingly enough, “A questionnaire survey of a random sample of 3321 nurses in Flanders, Belgium, indicated that 92% of nurses supported euthanasia for patients in uncontrollable pain” (Pesut et al National Library of Medicine 2019) So the three parties involved, realistically go down to two. How does the patient/family interaction happen based on a utilitarianism mindset? If the patient wants to die, but the family wants them to live, then it is unethical because more than one individual will be affected by the patient choosing to end their life early. Yet if the situation is investigated deeper, there is a utilitarian approach for physician assisted death. Questions such as how much is the government funding these individuals care? How many other patients could have been treated in the bed this patient is taking up? Or how much money is a family using to keep this person alive? An example would be a 72-year-old man with an LVAD, the surgeries, follow up visits, and readmissions have caused the family to burn through all their savings. Not only that, but the husband is deteriorating and is not looking to recover, is septic, facing a slow painful death. Now they are being told by their financial advisor that if they keep going, they will have to sell their house and use the remaining retirement funds they must continue care. Now the utilitarian lens shifts to a broader view of quality of life from the patient to the family. The people have a daughter who is financially dependent on the family. The patient might want to continue living, but in this scenario the utilitarian principles would say to maximize happiness, the husband should provide a way to best care for his family. In this way all affected individuals get maximum happiness. The family is taken care of, and the husband can pass while still holding cognitive power. In the end, “an autonomous, rational, and self-aware individual, his/her decisions, including those about time and circumstances of death, should be respected.” (Grasi et al. Complex Medical-Psychiatry Issues 2022) Meaning, the patient should be responsible for requesting the physicians assistance in death, and if the patient is unable to voice that opinion, and has no legal documents stating it, the family should not make that decision on their behalf.
In our textbook on page 105, the idea of need is criticized as ambiguous and it can not be defined, thus resulting in an unrealizable goal. This idea is at the utmost front of the debate on physician assisted death. A patient will never have a need to die, nor could that need be defined in such a way that it is universally applicable. However, a patient might have a want to die. The idea of a patient wanting to die could lead to moral dilemmas. The nurse could hold individual beliefs about physician assisted death resulting in a relationship that becomes more than professional. (Textbook page 285) Additionally, nurses are required to follow the standard of care which has the force of the law behind it. (Textbook page 275) This is all important because as Aristotle said, “we are like a ship at sea, we can control where we want to end up, but the path taken might not be straight and narrow”. Specifically, nurses and physicians want to do their best to take care of their patients, to help get them better so they can return to life, but there will be times that is unattainable. In these unattainable aspects, would it not be better to allow the individual to decide? Using a straight ethical ruler for these situations is not possible.
Another interesting thing to look at when discussing physician assisted death is the virtue ethics of it. The goal of virtue ethics is to reach eudemonia, a whole, complete, fulfilled self. Is it ethical to keep a person alive and force them to deteriorate, losing that wholeness, completeness, and fulfillment? If the person has experience, reason, and practical wisdom in requesting the death. Then by taking this action they maintain their sense of virtue, their sense of quality, and they stay true to their own behaviors accepting the consequences. Knowing that through a virtue ethics lens, that individual knows the morality of the decision is based on the summation of their lives and not just the ending of the life. As summarized in The Journal of Pain and Symptom Management, “an attending physician outside the hospice setting undertakes an assessment of decision-making capacity, oversees an informed decision or consent process, and writes the prescription for the patient.” (Campbell et al Jouranl of Pain and Symptom Management 2014) By following this process we allow the individuals to give into their desires in the right circumstances, in the right way, and for the right reason.
In conclusion, allowing for physician assisted death is moral and ethical through Kantianism, utilitarianism, and virtue ethics. These decisions should be able to be made by the individuals regardless of whatever authority is above them in that time. By not allowing for this decision to be made, we are taking away individual morality and ethics and replace it with forced morality.

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